Abstract Background Androgen-deprivation therapy (ADT) has been suggested to increase the risk for cardiovascular diseases, including myocardial infarction (MI) and stroke, but data are inconsistent. ...Objectives To investigate the association between ADT and risk for MI and stroke in Danish men with prostate cancer. Design, setting, and participants A national cohort study of all patients with incident prostate cancer registered in the Danish Cancer Registry from January 1, 2002, through 2010 was conducted. Outcome measurements and statistical analysis We used Cox regression analysis to estimate hazard ratios (HR) of MI and stroke for ADT users versus nonusers, adjusting for age, prostate cancer stage, comorbidity, and calendar period. Additionally, we stratified the analysis on preexisting MI/stroke status. Results and limitations Of 31 571 prostate cancer patients, 9204 (29%) received medical endocrine therapy and 2060 (7%) were orchidectomized. Patients treated with medical endocrine therapy had an increased risk for MI and stroke with adjusted HRs of 1.31 (95% confidence interval CI, 1.16–1.49) and 1.19 (95% CI, 1.06–1.35), respectively, compared with nonusers of ADT. We found no increased risk for MI (HR: 0.90; 95% CI, 0.83–1.29) or stroke (HR: 1.11; 95% CI, 0.90–1.36) after orchiectomy. One limitation of the study is that information on prognostic lifestyle factors was not included and might have further informed our estimates. Conclusions In this nationwide cohort study of >30 000 prostate cancer patients, we found that endocrine hormonal therapy was associated with increased risk for MI and stroke. In contrast, we did not find this association after orchiectomy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract
Background
Extended, more effective breast cancer treatments have increased the prevalence of long-term survivors. We investigated the risk of late breast cancer recurrence (BCR), 10 years ...or more after primary diagnosis, and associations between patient and tumor characteristics at primary diagnosis and late BCR up to 32 years after primary breast cancer diagnosis.
Methods
Using the Danish Breast Cancer Group clinical database, we identified all women with an incident early breast cancer diagnosed during 1987-2004. We restricted to women who survived 10 years without a recurrence or second cancer (10-year disease-free survivors) and followed them from 10 years after breast cancer diagnosis date until late recurrence, death, emigration, second cancer, or December 31, 2018. We calculated incidence rates per 1000 person-years and cumulative incidences for late BCR, stratifying by patient and tumor characteristics. Using Cox regression, we calculated adjusted hazard ratios for late BCR accounting for competing risks.
Results
Among 36 924 women with breast cancer, 20 315 became 10-year disease-free survivors. Of these, 2595 developed late BCR (incidence rate = 15.53 per 1000 person-years, 95% confidence interval = 14.94 to 16.14; cumulative incidence = 16.6%, 95% confidence interval = 15.8% to 17.5%) from year 10 to 32 after primary diagnosis. Tumor size larger than 20 mm, lymph node–positive disease, and estrogen receptor–positive tumors were associated with increased cumulative incidences and hazards for late BCR.
Conclusions
Recurrences continued to occur up to 32 years after primary diagnosis. Women with high lymph node burden, large tumor size, and estrogen receptor–positive tumors had increased risk of late recurrence. Such patients may warrant extended surveillance, more aggressive treatment, or new therapy approaches.
Objective
Juvenile idiopathic arthritis (JIA) may cause functional impairment and reduced time engaged in physical activity. The aim of this study was to investigate the habits of patients with JIA ...regarding participation in club sports, leisure‐time physical activity, and school‐educational physical activity and relate this to objectively measured physical activity using accelerometry and to compare the findings with those in healthy controls.
Methods
Consecutive patients from the Aarhus University Hospital outpatient clinic were included. Clinical characteristics, functional ability, and exploration of specific habits in club sports, leisure‐time physical activity, and school‐educational physical activity (based on a standardized questionnaire) in patients were recorded and compared with those in healthy controls. The intensity and frequency of physical activity were measured by accelerometer monitoring, using ActiGraph GT1M.
Results
Sixty‐eight patients with JIA and 118 healthy control subjects were included. Despite having low disease activity, children with JIA had significantly lower accelerometry‐monitored physical activity levels compared with healthy controls. The distribution of specific club sport activities was the same among patients and controls. However, the proportion of patients spending >3 hours/week participating in club sports was significantly lower than the proportion of controls, whereas no difference in time spent engaging in physical activity during leisure‐time was observed. Participation in compulsory school‐educational physical activity was equally high in patients and controls, although participation by patients was significantly less consistent than that by controls. Patient reports of time spent with club sport and leisure‐time physical activity was significantly related to accelerometry measures, whereas this was not observed for school‐educational physical activity.
Conclusion
The results of this study indicate the need for structured guidance for all patients with JIA (including those with minimal disease activity) in both understanding and coping with the consequences of a low level of physical activity.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Population-based health care databases are a valuable tool for observational studies as they reflect daily medical practice for large and representative populations. A constant challenge in ...observational designs is, however, to rule out confounding, and the value of these databases for a given study question accordingly depends on completeness and validity of the information on confounding factors. In this article, we describe the types of potential confounding factors typically lacking in large health care databases and suggest strategies for confounding control when data on important confounders are unavailable. Using Danish health care databases as examples, we present the use of proxy measures for important confounders and the use of external adjustment. We also briefly discuss the potential value of active comparators, high-dimensional propensity scores, self-controlled designs, pseudorandomization, and the use of positive or negative controls.
Abstract Patients with primary chronic immune thrombocytopenia (ITP) have immune-mediated platelet destruction and/or suppressed platelet production. ITP patients are, due to the thrombocytopenia, at ...increased risk of severe bleeding episodes. Paradoxically, these patients also seem to have an increased risk of venous thromboembolism (VTE). Findings from a Danish study including 391 patients with chronic ITP and 3,128 comparisons from the general population have suggested a more than twofold higher risk of VTE in patients with chronic ITP compared with the general population. VTEs may occur even in patients with low platelet count. The conclusion is therefore that clinicians should keep VTE in mind as a potential diagnosis in patients with chronic ITP.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Data on long-term risk of cancer after a postmenopausal bleeding diagnosis are sparse.
We used Danish medical registries to conduct a population-based cohort study of women with a first ...hospital-diagnosed postmenopausal bleeding during 1995-2013. We computed the absolute risk of cancer and the standardised incidence ratio (SIR) comparing the observed cancer incidence with that expected in the general population.
Among 43,756 women with postmenopausal bleeding, the absolute 1- and 5-year risk of endometrial cancer were 4.66% and 5.18%, respectively. The SIR of endometrial cancer was elevated during 0-3 months (SIR = 330.36 (95% CI: 315.43-345.81)), 3-12 months (SIR = 11.39 (95% CI: 9.79-13.17)), 1-5 years (SIR = 2.55 (95% CI: 2.19-2.94)) and >5 years of follow-up (SIR = 1.63 (95% CI: 1.40-1.90)). All selected gynaecological and urological, gastrointestinal and haematological cancers had elevated 0-3 months SIRs. Beyond 1 year of follow-up the SIRs of ovarian and bladder cancer remained elevated with a 1-5-year SIR of 2.15 (95% CI: 1.71-2.65) and 1.45 (95% CI: 1.14-1.80), respectively.
In the Danish population, women with a first hospital-diagnosed postmenopausal bleeding have an increased 0-3 months risk of gynaecological, urological, gastrointestinal and haematological cancers. The SIR of endometrial, ovarian and bladder cancer remained elevated for several years.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Only few smaller studies have examined if impaired kidney function increases the risk of acute kidney injury in patients with acute pyelonephritis. Therefore, we estimated 30-day risk of acute kidney ...injury by preadmission kidney function in patients with acute pyelonephritis. Furthermore, we examined if impaired kidney function was a risk factor for development of acute kidney injury in pyelonephritis patients.
This cohort study included patients with a first-time hospitalization with pyelonephritis from 2000 to 2017. Preadmission kidney function (estimated glomerular filtration rate (eGFR) <30, 30-44, 45-59, 60-89, and ≥90 ml/min/1.73 m2) and acute kidney injury within 30 days after admission were assessed using laboratory data on serum creatinine. The absolute 30-days risk of acute kidney injury was assessed treating death as a competing risk. The impact of eGFR on the odds of acute kidney injury was compared by odds ratios (ORs) with 95% confidence intervals estimated using logistic regression adjusted for potential confounding factors.
Among 8,760 patients with available data on preadmission kidney function, 25.8% had a preadmission eGFR <60. The 30-day risk of acute kidney injury was 16% among patients with preadmission eGFR ≥90 and increased to 22%, 33%, 42%, and 47% for patients with preadmission eGFR of 60-89, 45-59, 30-44, and <30 respectively. Compared with eGFR≥90, the adjusted ORs for the subgroups with eGFR 60-89, 45-59, 30-45, and <30 were 0.95, 1.32, 1.78, and 2.19 respectively.
Acute kidney injury is a common complication in patients hospitalized with acute pyelonephritis. Preadmission impaired kidney function is a strong risk factor for development of acute kidney injury in pyelonephritis patients and more attention should be raised in prevention of pyelonephritis in patients with a low kidney function.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The purpose was to describe utilization of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), including trends in prevalence, characteristics of ...users, drug switching and changes in prescribed doses in a large group of pregnant women across four Nordic countries.
A drug utilization study based on linked individual-level data from the nationwide prescription- and medical birth registers in Denmark, Iceland, Norway and Sweden. The study population comprised all pregnancies in these countries, resulting in a live birth or stillbirth after gestational week 22 from January 1st 2008 to December 31st 2012 (N = 1 162 470). In addition to the main study drugs SSRIs and SNRIs, we included (concurrent) use of other antidepressants, antipsychotics, anxiolytics and hypnotics.
A total of 38 219 (3.3%) pregnancies were exposed to SSRIs and 5 634 (0.5%) to SNRIs. Prevalence of SSRI and SNRI use varied by country (1.8% in Norway to 7.0% in Iceland). Use and prescribed dosages decreased with each passing trimester of pregnancy; prevalence was 2.7% at conception, and 2.1%, 1.7% and 1.3% respectively in 1st, 2nd and 3rd trimester. In 0.6% of pregnancies women filled a prescription before pregnancy and in every trimester. In one third of exposed pregnancies, women were also dispensed anxiolytics, hypnotics or sedatives.
Use of SSRI and SNRI use during pregnancy varied between the Nordic countries, but the overall prevalence remained low and relatively stable from 2008 to 2012. The low prevalence of use and high proportion of women who discontinue treatment in pregnancy raise questions about adequate treatment of depression in pregnant women.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary
Studies have reported a 1·3‐ to 2·2‐fold higher mortality rate among patients with primary immune thrombocytopenia (ITP) compared to the general population. However, long‐term mortality ...estimates as well as cause‐specific mortality data are sparse. In our population‐based cohort of adult patients with newly diagnosed ITP and up to 37 years of follow‐up, the 5‐year, 10‐year and 20‐year mortality among the ITP patients was 22%, 34% and 49%, respectively. The mortality in the ITP cohort was consistently higher than in the in the general population cohort yielding an adjusted hazard ratio (HR) of 1·5 95% confidence interval (CI): 1·2–1·8. The adjusted HRs of mortality due to cardiovascular disease, infection, bleeding and haematological cancer were 1·5 (95% CI: 1·1–1·5), 2·4 (95% CI: 1·0–5·7), 6·2 (95% CI: 2·8–13·5) and 5·7 (95% CI: 2·1–15·7), respectively, whereas mortality due to solid cancer and other causes were similar in ITP patients and the general population. We conclude that mortality rates among ITP patients are higher than in the general population, predominantly as a result of increased cardiovascular disease, infection, bleeding and haematological cancer cause‐specific mortalities.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
10.
The impact of comorbidity on cancer survival: a review Søgaard, Mette; Thomsen, Reimar Wernich; Bossen, Kristine Skovgaard ...
Clinical epidemiology,
2013-Nov-01, 2013-11-00, 20131101, 2013-11-01, Volume:
5, Issue:
Suppl 1
Journal Article
Peer reviewed
Open access
A number of studies have shown poorer survival among cancer patients with comorbidity. Several mechanisms may underlie this finding. In this review we summarize the current literature on the ...association between patient comorbidity and cancer prognosis. Prognostic factors examined include tumor biology, diagnosis, treatment, clinical quality, and adherence.
All English-language articles published during 2002-2012 on the association between comorbidity and survival among patients with colon cancer, breast cancer, and lung cancer were identified from PubMed, MEDLINE and Embase. Titles and abstracts were reviewed to identify eligible studies and their main results were then extracted.
Our search yielded more than 2,500 articles related to comorbidity and cancer, but few investigated the prognostic impact of comorbidity as a primary aim. Most studies found that cancer patients with comorbidity had poorer survival than those without comorbidity, with 5-year mortality hazard ratios ranging from 1.1 to 5.8. Few studies examined the influence of specific chronic conditions. In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology. Presence of specific severe comorbidities or psychiatric disorders were found to be associated with delayed cancer diagnosis in some studies, while chronic diseases requiring regular medical visits were associated with earlier cancer detection in others. Another finding was that patients with comorbidity do not receive standard cancer treatments such as surgery, chemotherapy, and radiation therapy as often as patients without comorbidity, and their chance of completing a course of cancer treatment is lower. Postoperative complications and mortality are higher in patients with comorbidity. It is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comorbidity.
Despite increasing recognition of the importance of comorbid illnesses among cancer patients, major challenges remain. Both treatment effectiveness and compliance appear compromised among cancer patients with comorbidity. Data on clinical quality is limited.
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